Prehospital Emergency Medical Services Challenges in Disaster; a Qualitative Study

Introduction: Prehospital Emergency Medical Care (EMC) is a critical service in disaster management. The aim of this study was to explore the challenges of prehospital Emergency Medical Services (EMS) during disaster response in Iran.Methods: A qualitative study was conducted from April 2015 to March 2017. Data were collected through in-depth, semi-structured interviews with 23 experienced individuals in the field of disaster that were selected using purposeful sampling. Data were analyzed using content analysis approach.Results: Fifteen sub-themes and the following six themes emerged in the analysis: challenges related to people, challenges related to infrastructure, challenges related to information management systems, challenges related to staff, challenges related to managerial issues and challenges related to medical care.Conclusions: Iran’s prehospital EMS has been chaotic in past disasters. Improvement of this process needs infrastructure reform, planning, staff training and public education.

Implementation requirements for patient discharge planning in health system: a qualitative study in Iran

Background: Effective discharge planning plays a vital role in care continuity and integrated care. Identifying and providing infrastructures for discharge planning can reduce avoidable hospital readmissions and finally lead to improvement of quality of care. The current study aimed to identify the requirements of discharge planning from the perspective of professionals in the health system of Iran.Methods: For the purposes of this qualitative study, semistructured interviews and sessions of focus group discussions with experts in the field were conducted. The data were analyzed using a thematic and framework analyses method. The study population was 51 participants including health policy makers, hospital andhealth managers, faculty members, nurses, practitioners, community medicine specialists and other professionals of the Ministry of Health andMedical Education (MOHME).Results: According to the control knobs (health reforms levels), recruitments of effective hospital discharge planning were divided into four areas, behavior (of policy makers, service providers, recipients services), organization, payment and financing and regulation (themes), in which there were 3, 7, 2 and 3 sub-themes respectively. Based on the findings of the interviews, they were categorized into the following main themes: behavior (policy makers, providers and patients), organizational change, financing and payment system and rules and regulations.Conclusions: According to the results of the present study, it appears to be essential for health managers and policy makers to pay attention to essential requirements of effective discharge planning.Keywords: Hospital discharge planning, health system,effective discharge plannin

Medical Tourism Attraction of Tehran Hospitals

Introduction: Today the market of medical tourism is growing as one of the competitive and profitable industries in the world. The aim of this study was to determine medical tourist attraction in Tehran hospitals. Methods: This is a descriptive study which was carried out in 8 hospitals of Tehran in 2012. 195 people from the managing boards of these hospitals participated in the study. A questionnaire was designed to gather data. The validity of the questionnaire was confirmed by professors and administrators and reliability was calculated 80% by Cronbach's alpha. The data was analyzed using SPSS. Findings: The total amount of medical tourist attractions in Tehran hospitals is moderate (51%) and also average number of foreign patients admitted to hospitals and average income for hospitals is also moderate. Conclusion: According to the results it seems media advertising is the most effective in attracting medical tourists. Furthermore, the advertisement of the capabilities of hospitals alongside marketing could help attract more medical tourists

Health Technology Assessment of TNK-ase vs. Reteplase in the Treatment of Acute Myocardial Infarction in Iran

Background & Objectives: Due to the lack of evidence about the most cost-effective thrombolytic drug in the treatment of acute myocardial infarction with the ascension of the ST segment, this study was conducted to evaluate the cost effectiveness of tenecteplase, as a new medicine, versus Reteplase in the treatment of acute myocardial infarction patients with the ascension of the ST segment in Iran. Methods: This study was a type of health technology assessment study. We searched the MEDLINE, Cochrane Library (DARE-EED-HTA, Web of Science and EMBASE databases (from March1980 to March 2017) by using related keywords for finding cost-effectiveness, safety and economic studies. The qualities of studies were independently assessed by STROBE checklist and data were extracted using Cochrane data extraction form. Results: Three studies were eligible for inclusion and all three were of high quality. Mortality had been compared between Tenecteplase and Reteplase. The results of two studies with 781 samples had showed the same efficacy for Tenecteplase and Reteplase in regard to mortality rate. According to the cost-effectiveness analysis, Reteplase is more cost effective than TNKase (250 $versus 537.49$). Conclusion: Reteplase, due to the same safety and effictiveness but lower cost, is preferred to Tenecteplase and considering the current economic conditions of Iran, it is recommended to be used in the treatment of acute myocardial infarction patients with the ascension of the ST segment. Keywords: Health Technology Assessment, Acute Myocardial Infarction, Tenecteplase, Reteplase, Economic evaluation Citation: Bashzar S, Tourani S, Nikfar S, Ravaghi H, Habibi M. Health Technology Assessment of TNK-ase vs. Reteplase in the Treatment of Acute Myocardial Infarction in Iran. Journal of Health Based Research 2018; 4(1): 51-62

Validating and determining the weight of items used for evaluating clinical governance implementation based on analytic hierarchy process model

Background: The purpose of implementing a system such as Clinical Governance (CG) is to integrate, establish and globalize distinct policies in order to improve quality through increasing professional knowledge and the accountability of healthcare professional toward providing clinical excellence. Since CG is related to change, and change requires money and time, CG implementation has to be focused on priority areas that are in more dire need of change. The purpose of the present study was to validate and determine the significance of items used for evaluating CG implementation. Methods: The present study was descriptive-quantitative in method and design. Items used for evaluating CG implementation were first validated by the Delphi method and then compared with one another and ranked based on the Analytical Hierarchy Process (AHP) model. Results: The items that were validated for evaluating CG implementation in Iran include performance evaluation, training and development, personnel motivation, clinical audit, clinical effectiveness, risk management, resource allocation, policies and strategies, external audit, information system management, research and development, CG structure, implementation prerequisites, the management of patients’ non-medical needs, complaints and patients’ participation in the treatment process. The most important items based on their degree of significance were training and development, performance evaluation, and risk management. The least important items included the management of patients’ non-medical needs, patients’ participation in the treatment process and research and development. Conclusion: The fundamental requirements of CG implementation included having an effective policy at national level, avoiding perfectionism, using the expertise and potentials of the entire country and the coordination of this model with other models of quality improvement such as accreditation and patient safet

The Feasibility of Deploying Business Process Management in Hospitals in Iran

Background: Business process management systems (BPM) can automate all processes in an organization. These systems provide the possibility of identifying, modeling, deploying, implementing, function managing, integrating with other information systems, monitoring and improving an organization's business processes in a standard form. As far as the authors know, no related research has been performed in this field. Objective: This study investigated the feasibility of establishing business process management in hospitals in Iran. Methods: This qualitative research involved 13 participants selected by purposive sampling, including faculty members from medical universities and managers of hospitals. Data was collected through semi-structured interviews and analyzed using qualitative content analysis. Results: Interviewees were asked about the requirements for establishing BPM. To more easily understand the content, the interveiwees’ responses were classified into two general categories: prerequisites for guidelines and procedures, and prerequisites for electronic healthcare records. Conclusion: Despite slight differences between the two groups of respondents (healthcare administrative experts and medical informatics management experts), there was a consensus among the experts about the effectiveness and efficiency of using BPM in healthcare organizations. Furthermore, respondents maintained that, even though numerous prerequisites would be needed for the establishment of this kind of processing reform given the current situation in Iran, some benefit could be gained from implementing to any extent possible this approach in Iran’s hospitals

Measuring Safety Culture And Setting Priorities For Action At An Iranian Hospital

Objective: the objective of the study is to measure safety culture in an Iranian hospital. Method: The present descriptive study was carried out through a cross-sectional method during spring of 2008. Standard AHRQ questionnaire on patient safety culture survey was applied. Study population comprised of the hospital nursing staff. The survey was carried out on 239 nursing staff. Results: Supervisor expectations and actions promoting patient safety and teamwork within units were highest scored dimensions of hospital regarding patient safety. Among hospital weaknesses regarding patient safety, no punitive response to error and overall patient safety grade were most brilliant. Conclusion: The hospital can establish a safe environment by trying to overcome its weaknesses. Creating an events reporting system and encouraging personnel to report probable errors and events and taking non punitive actions is suggested to treat events

Evaluation Systems for Clinical Governance Development: a Comparative Study

Lack of scientific and confirmed researches and expert knowledge about evaluation systems for clinical governance development in Iran have made studies on different evaluation systems for clinical governance development a necessity. These studies must provide applied strategies to design criteria of implementing clinical governance for hospital's accreditation. This is a descriptive and comparative study on development of clinical governance models all over the world. Data have been gathered by reviewing related articles. Models have been studied in comprehensive review method. The evaluated models of clinical governance development were Australian, NHS, SPOCK and OPTIGOV. The final aspects extracted from these models were Responsiveness, Policies and Strategies, Organizational Structure, Allocating Resources, Education and Occupational Development, Performance Evaluation, External Evaluation, Patient Oriented Approach, Risk Management, Personnel's Participation, Information Technology, Human Resources, Research and Development, Evidence Based Medicine, Clinical Audit, Health Technology Assessment and Quality. These results are applicable for completing the present criteria which evaluating clinical governance application and provide practical framework to evaluate country's hospital on the basis of clinical governance elements

بررسی تأثیر مدیریت جامع کیفیت (FOCUS PDCA) بر عملکرد بخش کاردرمانی دانشکده توان‌بخشی شیراز

مقدمه: توان‌بخشی کودکان فلج مغزی از مباحث مهم در حیطه کاردرمانی می‌باشد. برنامه توان‌بخشی این کودکان فرایندی مستمر و درازمدت است که والدین را با مشکلاتی نظیر ماندن در لیست انتظار، جابجایی و حمل و نقل کودک و مسایل مالی مواجه می‌کند. این مشکلات می‌تواند پی‌گیری و اعتماد خانواده را به برنامه‌های درمانی کاهش دهد و دستیابی به هدف را به تعویق بیندازد. در پژوهش حاضر جهت ارتقای سیستم و رفع مشکلات ذکر شده، یکی از ابزارهای مدیریت جامع کیفیت به نام FOCUS-PDCA (Find, Organization, Clarify, Understanding, Select, Plan, Do, Check, Act) اجرا شد و تأثیر آن بر عملکرد بخش کاردرمانی دانشکده علوم توان‌بخشی دانشگاه شیراز مورد بررسی قرار گرفت. مواد و روش‌ها: مطالعه حاضر مداخله‌ای شبه تجربی بود که در دو گروه آزمون و شاهد انجام گرفت. در هر گروه 15 کودک فلج مغزی و والدین آن‌ها 12 جلسه تحت بررسی قرار گرفتند. گروه شاهد از خدمات کاردرمانی سنتی در کلینیک استفاده نمودند. پس از تشکیل تیم ارتقاء در گروه آزمون به جزء خدمات کلینیکی، آموزش والدین و انجام تمرینات در منزل نیز مورد استفاده قرار گرفت. رضایت‌مندی والدین در انتها توسط پرسش‌نامه محقق ساخته و عملکرد حرکتی درشت کودکان قبل و بعد از مداخله توسط مقیاس پی‌بادی (Peabody scale) در دو گروه مورد ارزیابی قرار گرفت. یافته‌ها: تحلیل داده‌ها حاکی از تأثیر معنی‌دار روشFOCUS-PDCA  در بخش کاردرمانی بر عملکرد حرکتی کودکان فلج مغزی (05/0 > P) و رضایت‌مندی والدین (001/0 > P) بود. نتیجه گیری: پژوهش حاضر نشان داد که اجرای روشFOCUS-PDCA  منجر به ارتقای عملکرد حرکتی درشت کودکان فلج مغزی و افزایش رضایت‌مندی والدین مراجعه کننده به کاردرمانی می‌گردد. پیشنهاد می‌شود که این روش در دیگر حیطه‌های درمانی و توان‌بخشی و از نظر تأثیر آن بر شاخص‌های دیگر نیز مورد ارزیابی قرار گیرد. کلید واژه‌ها: روش FOCUS-PDCA، بخش کاردرمانی، فلج مغزی، رضایت‌مندی والدی